Med Surg Exam # 2
• Pre-Operative Patient Care • Oxygenation Disturbances
• Post-Operative Patient Care • Sleep Apnea (podcast)
• Wound Care • Sinusitis/Acute Bronchitis (podcast)
• Oncology • Pneumonia (podcast)
Pre-Operative Patient Care
Surgery - art and science of treating disease, injuries, and deformities by operation and
instrumentation.
Classification of Surgery:
- Seriousness
- Major
- Minor
- Urgency
- Elective
- Urgent
- Emergency
Classification of Surgery
Purpose:
- Diagnosis: determine presence and/or extent of disease
- Cure: eliminate or repair pathology
- Palliation: alleviate symptoms without cure
- Prevention
- Exploration: surgical exam to determine nature and extent of disease
- Cosmetic Improvement
Surgical Settings:
Determined by:
- complexity of surgery
- potential complications
- general health status of patient
Inpatient (have surgery and stay overnight in hospital)
- same day admission
- in hospital prior to surgery
Ambulatory (outpatient) Surgery
- majority of surgeries
1 of 49
,- minimally invasive procedures
- sites:
- emergency departments
- endoscopy clinics
- physician’s office
- free standing surgical clinics
- outpatient surgery units in hospitals
Ambulatory Surgery
- can use general, regional, or local anesthesia
- operating time < 2 hours
- less than 24 hour stay postoperative
- benefits:
- generally preferred by patient and physician
- involves minimal lab tests
- requires fewer pre-op and post-op medications
- reduces patient susceptibility to hospital acquired infections
- cost is usually less for patient and insurer
Pre-Operative Interview and Assessment
*Overall Goal: determine risk factors
and determine plan to ensure safety
throughout surgical experience
Goals of Assessment:
- any problems with previous
surgeries / pt or family
- screen for malignant
hyperthermia risk
- determine physiologic risk factors
(PMH)
- establish baseline for comparison
during preoperative period
- identify prescription meds, OTC
meds, herbal supplements, and
recreational drugs used by the patient
- review all pre-op labs and testing that has been done
- identify and document surgical site
- identify any cultural or ethical factors that might affect the surgical experience
- determine psychologic status of patient in order to reinforce use of coping strategies during
surgical experience
- determine is informed consent has been completed
Pre-Operative Nursing Interventions
2 of 49
,Informed Consent:
- active, shared decision-making process between health care provider and the recipient of
care
- 3 conditions must be present:
- adequate disclosure
- clear understanding
- voluntary
- physician responsible for obtaining consent
- nurse may witness pt signature and confirms that pt understands all information
*IF pt says “I don’t want to know about the surgery just do it” What do you ?
- try to explain why it’s important information; if they REALLY don’t wanna know that is their
decision. DOCUMENT this.
Pre-Operative Interview and Assessment
Medications
- need accurate list of all medications being taken
- ask them to bring all medications in for accurate list
Specifics to think about:
- tranquilizers
- antihypertensives
- insulin or oral hypoglycemias
- ASA, NSAIDs, Plavix (any blood thinners bc will cause bleeding problems) TYLENOL can be
alternative!!
- Coumadin
- Specifically ask about herbals*
- ask about use of recreations drugs
*all body systems reviewed for risk factors and baseline*
1 THING THEY ARE ALLOWED TO LEAVE ON IN SURGERY: HEARING AID
Cardiovascular:
- cardiac clearance:
- consult with cardiologist
- coagulation studies
- EKAG, echocardiogram, stress test
- on diuretic, may need K+ checked pre-op
Respiratory:
- conditions likely to compromise respiratory function:
- smoking, sleep apnea, obesity, spinal, chest, airway deformities
- Respiratory clearance may include:
- consult with pulmonologist
- ABGs, CXR, pulmonary function tests
3 of 49
, Neurologic:
- crucial to get baseline cognitive function, especially elderly
- hearing and vision
Genitourinary:
- ability to void, incontinence; BPH may make it difficult to insert foley
- R/O pregnancy in women of childbearing age
- altered renal function can lead to F&E problems
- may need BUN/Creat, electrolytes
Hepatic:
- liver detoxifies many anesthetics and adjunctive meds
- ppl with liver disease may have increased risk for clotting abnormalities
Integumentary:
- condition of skin at potential surgical site
- risk for pressure ulcers
- tattoos and body piercings
Musculoskeletal:
- mobility restrictions may limit positioning and post-op ambulation
- spinal anesthesia may be difficult to person who cannot flex lumbar spine
- if next affected intubation may be difficult
- any mobility aides should be brought to facility with pt
Endocrine:
- diabetes and thyroid disease
Immune:
- allergies
- history of compromised immune status or taking immunosuppressive drugs
- corticosteroids should be tapered before surgery
- delays wound healing and increases risk for post op infection
Fluid and Electrolyte Status:
- S&S of vomiting or diarrhea
- use of diuretics
- pre op bowel preps
- NPO pre op may lead to hypovolemia
Nutritional Status
- dentures and bridges
- overnutrition or undernutrition can be problem
Surgical Events
4 of 49
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller anyiamgeorge19. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $12.99. You're not tied to anything after your purchase.